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Sepsis
A little less conversation, a little
more action please
Definitions
Systemic Inflammatory Response
Syndrome (SIRS)
Sepsis
Severe Sepsis
Septic Shock
SIRS
SIRS
2 or more of the following:
Temp >38C or <36C
HR >90 beats/min
RR >20 breaths/min or PaCO2 <4.5kPa
WBC >12,000 or <4000 cells/mm3, or
>10% immature (band) forms
Sepsis
Sepsis
SIRS in the presence of proven or
suspected infection
Severe Sepsis
Severe Sepsis
Sepsis associated with hypotension,
hypoperfusion and/or organ-dysfunction
Septic Shock
Septic Shock
Sepsis with hypotension despite
adequate fluid resuscitation
May be vasodilatory and/or
distributive shock
Include all patients on vasopressors or
inotropic support
Organ Failure
CVS
RS
Renal
Hepatic
CNS
Haematological
Case 1
You are called to Resus to review an 78 year old female
who presented with confusion, fever and rigors.
She is unable to give a history.
Her observations on admission are 38.30c, BP 70/35
Pulse 120 RR 30
Case 2
A ICU nurse asks you to urgently see an elective
cardiac patient who has just arrived from theatre,
ventilated but has had no medical handover
His obs are T35.5, BP 80/50, P100, CVP 10, SpO2 99
on 40% O2
Case 3
The A&E SpR calls to discuss the case of a 50 year old
overweight, hypertensive, diabetic female with upper
abdominal pain and shock. The surgeons have just
started an AAA repair in theatre.
Obs: T35, BP 90/40, P100, RR36, SpO2 unrecordable
What is the differential diagnosis?
What would you like to do next?
Oxygen delivery
What does it mean?
Oxygen delivery
What does it mean?
Fluid Challenge
What is the difference between an infusion and a
challenge?
Fluid Challenge
What is the difference between an infusion and a
challenge?
Fluid Challenge
Aim is to improve SV (and hence CO) by increasing
preload
Frank-Starling mechanism
Markers of perfusion
What are they?
Markers of perfusion
What are they?
Clinical signs
Warm skin, conscious level, u/o
Haemodynamic variables
CVP
Bloods
Serum Lactate
ScvO2
CVP
What does it mean?
CVP
What does it mean?
Starlings Law
Estimate of LVEDV (i.e. preload)
Not always a good correlation with
volume-responsiveness
However if low strongly suggestive of
hypovolaemia
Lactate
What does it mean?
Lactate
What does it mean?
Reduced metabolism
Hepatic
Renal
ScvO2
What does it mean?
ScvO2
What does it mean?
ScvO2
What can I do if its low?
ScvO2
What can I do if its low?
ScvO2
What can I do if its low?
SBP
MAP
CVP
U/o
Lactate
ScvO2
HCt
SBP > 90
MAP > 65
CVP 8 - 12
U/o > 0.5 ml/kg/hr
Lactate < 1
ScvO2 >70
HCt > 30
Further Management
What else can be done?
Further Management
What else can be done?
Any Questions?